House Health Care Bill: Its Path and Transparency

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Yesterday, the House of Representatives released a 1,018 page bill (H.R. 3200) to reform the nation’s health care system. This is the first step in the House in the long slog to pass health reform. The bill will go through many different steps, committees, markups, hearings and floor procedures before it comes out the other end. In this post, I will try and explain all of these steps while also detailing the areas where transparency problems may arise. At Sunlight, we’re trying to make sure that transparency in the entire legislative development of this bill is taken as a paramount concern by Congress.

The bill begins its journey when it is referred to committees with jurisdictional authority. In this case, there are three committees with direct jurisdiction over the health care reform bill: Education & Labor, Energy & Commerce and Ways & Means. Beginning this week, all three committees will hold markups on the bill. While the committees have slightly different jurisdictional authority — Ways & Means covers tax provisions, Medicare and Medicaid and Education & Labor covers workplace protections — they will all discuss the central, and most controversial, piece of health care reform, the public option. From the announced schedules of the committees (see the bottom of this post), the bill will be in Energy & Commerce for the longest period of time.

Transparency issues are bound to come up during these committee markups. The most pressing issue is the disclosure of amendments to be offered in committee during the markups. Will the amendments be disclosed prior to voting? During voting? Amendments should wind up in committee reports, along with the vote tallies — barring a voice vote, which is not recorded — but sometimes these are not posted to the committee web sites. The three committees should consider making this process as open as possible by providing a list of amendments offered online. The Rules Committee does this and I don’t see why these committees couldn’t do it too. (I’m told from independent sources that Ways & Means may be the worst committee for transparency, as they have yet to get proactive about posting materials to their web site as the other two committees have.)

The real problem, as it relates to transparency, will arise once the tri-committee markup is complete. The likely outcome of the tri-committee markup is that there will be competing versions of the bill that will need to be reconciled between the committee chairs, leadership and wayward Democrats seeking to influence the bill. This is exactly what happened with the cap and trade bill. The reconciliation between the committee chairs will not be done in open session and could result in a very different bill than the one that came out of the three committees. That being the case, there are good reasons to believe that a committee chair reconciliation will not result in the same outcome as the cap and trade bill. Here’s why:

The issue with cap and trade was that only Energy & Commerce held hearings on the bill. The bill was never considered in open session before the other eight committees with jurisdiction. Instead, the committee chairs met and hashed out a compromise behind closed doors and released a different bill that wasn’t even complete. Unlike this process, the health reform bill will be reviewed in open session in all three committees and copies of the marked up bill language should be available, although perhaps in less than ideal quality, for the public to see and read. Thus, there shouldn’t be as many surprises as the cap and trade committee compromise brought.

So, what happens after the committee chairs get together and put their versions of the bill together? The bill needs to go through one more committee: the Rules Committee. In a Rules Committee session the members will consider amendments to be offered during debate on the floor of the House. The committee will likely review over 200 amendments, rejecting most and allowing only a few. There is also the possibility that a manager’s amendment will be considered, much like the cap and trade bill. The Rules Committee has been historically notorious for its lack of transparency. Lately it has been better than many other committees in disclosing committee amendments and reports online, but sessions are sometimes held late in the day, often going late into the night. The committee room is also not equipped with video equipment to televise the hearings online.

Finally, the bill will reach the floor of the House for consideration. This is pretty self-explanatory and will likely feature votes on amendments, a vote on a motion to recommit and a final vote on passage. All will be televised.

Below is the announced committee schedule:

July 15: Education & Labor holds first markup. Only opening statements made.

July 16: Education & Labor continues markup with introduction of amendments and voting. Energy & Commerce begins markup (2:00 pm). Ways & Means begins markup (9:00 am).

July 17: Energy & Commerce continues markup.

July 20: Energy & Commerce continues markup.

July 21: Energy & Commerce continues markup.

July 22: Energy & Commerce continues markup.

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  • Robert Puvski

    There’s a guy on youtube who created really nice explanations of what’s coming with this bill, I think it’s a must see for everyone:
    http://lil.cx/10000pennies

  • james mcauley

    How dare the govt restrict the amount a private insurance company can make. This is a free country and companies should be allowed to make money any way they want. Absolutely disgusting that govt is getting in the way of CEOs and how they want to run a company. If the company don’t want to cover someone who already has cancer, then they shouldn’t be forced to. Or if a couple has a child with a gross disorder, why should the company have to pay for it.
    Leave businesses alone to make the best decisions, capitalism will always work the best for the people.

  • If only everyone could see that the “Blue Dog” team are referring to an ancient old government. That was ran like any other government. That the animal kingdom was, and still is important. But we really need people who suffer everyday crisis with their unsupported health needs to be allowed to finally have their say now. We can not afford to let this slide any longer, or blanket the cost of health care without thinking of the more than 50-80% of this nation going without health care needs. Fullknowing that we have been through a war to help other people have a democracy of their very own. I think the “Blue Dog” senate commitee ought to think about their committee name. Some would think the senate has moral issue or even a moral difficency.

  • Concerned

    Also,

    Why don’t the president have balls like Andrew Jackson had?????? Hello???

  • Concerned

    I’m with KTULU. GET RID OF THE FEDERAL RESERVE !!!!!!!! Give every American Citizen the same health care senators and representatives get, PERIOD.

  • William Hall

    The president says you can keep you on insurance and you can but you better read pages16 and17 of the bill. If anything changes with your plan at all you will go on the government plan or face fines and jail time. If you are a senior or disable person you had better read pages 425-430 because you will only be allow to die under the government plan. Google defend your health care and educate yourself on the hazards of this bill. Most important of all if this bill was so great why want the president, congress, senate, unions, and all government worker be put on this plan since we the people pay for their insurance. Seams to me if I have to pay for the president and all government workers then they should have the same insurance that is avaliable to me.

  • Stacey

    I feel that EVERYONE on this blog, after reviewing your comments, should contact your Congressman and ask if they have read the entire bill. If yes, they are probably lying and if not, then ask them to VOTE NO!

    We can still make change without rushing through the details! The “details” the Obama administration and bill supporters would like to HIDE by making our citizens feel a it’s “DO NOW or WE’RE DAMNED”, is simply not true. If these intelligently manipulative government committees, bill writers, etc. can so efficiently create this 1018 page document that will solve all of our health care problems, (as they allege) then I’m sure if it’s dropped, they can find other solutions!! Hum, now isn’t that a crazy thought!

    Slow down people! The urgency is imperative in their minds. If they move quickly, like a lightening bolt, and succeed by keeping us “secure” under their house of bricks, we may be crushed below the gravity or emerge to the remnants of the freedoms we were, as the United States of America, founded upon!

    NO TO THIS BILL! Contact 202-224-3121 or go to their websites and send an email. NOW WE HAVE TO FLOOD their phones, emails, all web-based communications and/or media outlets to let our VOICES be heard! It’s OUR COUNTRY and if we complain, yet don’t take action, we are dead in the water.

  • Phyllis Heller

    Dave Pollock said it well with the old adage of rob Peter to pay Paul. How does that translate? It’s a ponzi scheme. Look at all that has transpired and it makes Madoff look like peanuts. Now it’s healthcare and with few exceptions. we have the best in the world. It’s the insurance and pharmaceutical companies, along with unions that have to be addressed. They along with congress are in MDC mode (mismanaged, dysfunctional, corrupt). Get rid of the gatekeepers, paper pushers,lobbyists, patronage, etc. and out of the 50million, make the 35M or so who do not want to pay, pay out of pocket and illegals turned away from emergency rooms for colds, sore throats, hemorrhoids. And we have always taken care of the pooor/indigent. Like the rest of you, I am angry and it’s time for term limits because congress has become a lifelong family business. I love this country, the home of the free because of the brave. Let’s keep it that way.

  • rbblum

    It would be of interest to address the issue that since Medicare is currently on an unsustainable financial track, why would there be any assurance that the current financial track will be altered or avoided by incorporating Medicare into the new National Healthcare program; being able to maintainin the original quality of services and standards to an increasing, aging client base.

    In other words, the inherent healthcare industry problems will still prevail, just more hidden or buried . . . further building upon the concept of too big to fail . . . at taxpayers expense.

  • HBW

    This was an excellent run-down. Even if it seems elementary, it provides an organized look at the food-chain, and where the gaps in civilian overview happen.

  • Mike

    I think what should happen is that the American people should get the kind of insurance the President and Congress gets. Or let them have what we are going to get. If that isnt good enough leave things alone.

  • New John Adams

    Isn’t it tyrany to legislate that every one of us must purchase government-defined health insurance or face new taxes and fines?
    Isn’t it scary that the government by the Benefits Advisory Committee – and the Secretary of Health and Human Services will decide what coverage you have to pay for and what diseases and treatments will be covered?
    Why aren’t more Americans concerned about More Comparative Effectiveness Research that could lead to government bureaucrats denying you health care treatment options?

  • Ktulu

    …I agree with Patricia. Except the train is on a bridge over a lake of napalm so we can’t even jump off it…

    We don’t even really have money anymore though… and the crap we have is becoming worth less every day.

    Fix the Economy Step 1: Get rid of the Federal Reserve

  • Dave Pollock

    Government which robs Peter to pay Paul can always depend on the support of Paul.
    — George Bernard Shaw

  • Patricia

    The most frustrating part of this equation is even after we complain, we can’t stop this. It is like being on a fast moving train with no brakes and a drunk driver at the helm who has no concern for the safety of the passengers.

  • This is as close to having a king as has
    ever been in this country. With the democratic congress with a leader like
    Pelosi who is trying to rubber stamp everything that he and the liberal democrats want the country does not stand
    a chance.The confusion for the average
    person is to much. They just have been
    getting away with what they want.The thing is that Americans just do not want to realize is that we did not cause the problem. It was all congress talking money and turning there head.How could I
    see we were in trouble and I know nothing.We can not expect them to fix it
    they need all this money to run for office and they love to spend OUR MONEY.

  • joe somario

    Was Dodd blowing smoke when he promised Tom Coburn that Dodd would ask the GOA to price out what Tom Coburn presented along with his other conservative Senators? Heaven forbid we would think of saving money.

  • Caitlin

    “We’re going to have 2 million to 4 million people pay for all of this when they are already paying 70 percent or 60 percent of all the tax income in this country. Where does this make sense?” Thank you CNBC! http://www.newsy.com/videos/the_democrats_new_plan

    With the economy currently failing, maybe the Democrats should start focusing on fixing the economy instead of spending more of middle class money.

  • Tom North

    I am extremely concerned that, in a deliberate attempt to sugar coat the bills to make them appeal to the voting public, the Democratic leadership is already spinning them and burying the unconstitutional problems of the bills into the small print without mentioning them. In particular, both the Senate and House bills contain unconstitutional attempts for government to do something our federal government has never attempted before. That is to mandate that ALL American citizens do something just by virtue of existing, in this instance, obtain or accept health insurance, and mostly at the citizen’s expense. This is not like car insurance which as to do with the legal privilege of driving, or mandatory jury duty, military draft or education, all of which can be opted out of under circumstances. This is Big Brother, representatives we elect to do what we tell them, instead trying to boss us around with no opt out. This is Big Government trying to tell us what to do, how to spend our own earnings, and that we must annually report our most private, personal health information (insurance info.), even though it is absolutely none of government’s business. I decline to do so, no matter what they try to do to me. Individual free choice prevails over government mandates in a free nation.